Airway maintenance refers to the continuous efforts and techniques used to ensure that a person’s airway remains clear and open, allowing for efficient breathing. This is critical in a variety of healthcare settings, especially during emergency situations when an individual’s ability to breathe is compromised.

There are several methods that can be used to maintain a patent airway, including:

• Positioning: Correct positioning of the head and neck is fundamental. These include techniques such as head tilts and chin lifts or jaw thrust forward and upward maneuvers, which can help align and open the airway.
• Aspiration: In cases of airway obstruction due to secretions, blood or other fluids, suction is used to remove such obstructions and ensure a clear airway.
• Airway aids: Various devices can be used to maintain a patent airway. Oropharyngeal or nasopharyngeal tubes are common airway management aids that help prevent the tongue from blocking the airway and allow for more efficient airflow.
• Oxygen therapy: administration of oxygen through various methods, such as nasal catheters, masks, or mechanical ventilation, helps ensure an adequate supply of oxygen to the patient’s lungs and bloodstream.
• Intubation: Endotracheal intubation is a procedure in which a tube is inserted into the trachea to secure an airway. This is usually performed in more serious cases or during surgical procedures.
• Supraglottic Airway Pomlaaga: These devices, such as the Laryngeal Mask (LMA), provide a safe and temporary airway for patients who require ventilation or are at risk of airway compromise.
• Cricothyrotomy: In extreme cases when all other methods fail, a cricothyrotomy is performed to create an artificial airway.

The specific method chosen to maintain airway patency depends on the patient’s condition, the available equipment and the expertise of the healthcare professional. A quick and appropriate response is essential to ensure that the patient continues to receive an adequate oxygen supply and can breathe effectively.

Air passes through open and clear airways during normal, silent, effortless breathing. If a person can respond in a normal voice without accompanying sounds, we can conclude that his airways are open and passable. Signs suggestive of a compromised airway include snoring sounds (partial obstruction due to backward tongue drop, presence of foreign body, edema) or gurgling/gurgling (presence of liquid contents requiring aspiration), hoarseness, inspiratory stridor (inspiratory stridor), expiratory rales (expiratory wheezing), labored breathing and possible coughing. In such cases, conscious patients may complain of suffocation and appear visibly distressed. In case of complete obstruction of the airways, air can no longer pass, and the person cannot breathe, speak or cough. There may be a paradoxical movement of the chest and abdomen, such as “rolling”, where the chest moves inward and the abdomen expands during an attempt to inhale, and vice versa during an attempt to exhale.

Possible causes of a compromised airway include:

• Pulling back of tongue and soft tissues due to altered consciousness
• Blood
• Stomach contents due to vomiting or regurgitation
• Foreign bodies (e.g. food, dentures)
• Swelling due to infection, anaphylaxis or burns
• Bronchial secretions that a person cannot cough up on their own
• Injury
• Laryngospasm and bronchospasm
• Tracheostomy obstruction

The first task in emergency care is to establish an open and clear airway, which can be achieved by simple procedures such as tilting the head and raising the chin, pushing the lower jaw forward and upward, aspirating the contents of the airway (e.g. vomit or blood) and placing airway assist devices such as oropharyngeal or nasopharyngeal tubes. Such patients are likely to require oxygen administration with arterial blood oxygen saturation targets of 94-98% (in conditions prone to hypercapnia, such as COPD, target values ​​are 88-92%, and in acute ST-segment elevation myocardial infarction, oxygen supplementation it is considered only if arterial blood oxygen saturation falls below 90%). These procedures do not ensure a completely patent airway, and to achieve complete patency we use endotracheal intubation or supraglottic airway devices.

Endotracheal intubation is the gold standard for airway protection because when the cuff of the endotracheal tube is inflated, it acts as a barrier that prevents foreign substances from entering the airway, such as secretions from the upper respiratory tract, blood, regurgitated contents of the digestive system, or other foreign objects. However, endotracheal intubation is not always possible, especially in prehospital settings. In cases where all previous methods to protect the airways have failed, cricothyrotomy may be necessary.

PERSONAL PROTECTION MEASURES: As with all medical procedures, personal protection is essential. When performing procedures to establish airways, it is mandatory to use protective gloves, a mask and protective glasses. We wear protective equipment to prevent skin contact and to protect the eyes and respiratory tract from the patient’s blood or other bodily fluids, thus avoiding the transmission of infectious diseases.